Risk Factors Associated With Hospitalization, Severity, and Mortality From COVID-19 Among Children and Adolescents in Mexico

Introduction Mexico has seen a high number of COVID-19 cases and deaths among children. The majority of cases were in Mexico City and the State of Mexico. There is heterogeneity in the clinical and epidemiological parameters of risk or protection at the national and international levels in this age group. The objective of the study is to identify the epidemiological and clinical factors associated with severe COVID-19, hospitalization, pneumonia at admission, and mortality among children and adolescents. Materials and methods A retrospective, analytical, and multicenter study based on hospital patients was conducted between 2020 and 2023 in four general and regional hospitals of the Mexican Social Security Institute (IMSS), Mexico. A total of 1,698 subjects diagnosed with COVID-19, aged between one and 17 years of both sexes, were included. Multiple binary logistic regressions were performed and stratified by laboratory diagnosis, obtaining simple and adjusted ORs for the clinical and epidemiological variables associated with severe COVID-19. Results The model adjusted and stratified by laboratory diagnosis for COVID-19 severity showed that obesity had an OR of 2.46 (95% CI, 1.37-4.43), being under five years of age had an OR of 2.01 (95% CI, 1.43-2.84), headache had an OR of 2.00 (95% CI, 1.18-3.39) and dyspnea had an OR of 1.82 (95% CI, 1.06-3.11). In the unadjusted analysis, male sex was associated with an OR of 1.82 (95% CI, 1.4-2.2) for severity. Conclusion The results suggest that being under five years of age, being overweight or obese, and experiencing cough, headache, and dyspnea are risk factors for COVID-19 complications in the hospital setting, based on clinical diagnosis. These findings have very limited applicability to mild community-acquired cases. Prospective cohort studies are needed to confirm these findings and include pediatric anthropometric standards.